National Trends in Pediatric Meningioma Management and Outcomes: A National Cancer Database Study

Introduction: Meningioma in pediatric patients are rare. Our study seeks to analyze a large cohort of pediatric patients from the National Cancer Database (NCDB) with meningiomas to determine patient demographics, treatment patterns and associated outcomes of this cohort.

Methods: The NCDB was queried from 2004 to 2018 for pediatric (aged ≤ 21) patients diagnosed with histologically confirmed meningiomas. Data regarding sociodemographics, tumor characteristics, and treatment modalities were extracted. The primary outcome of interest was overall survival (OS), which was evaluated for using univariate and multivariate Cox proportional hazard models along with associated survival curves and Kaplan–Meier analyses. Secondary outcomes of interest included utilization of treatment modalities (surgery and radiotherapy) and early postoperative outcomes (prolonged length of stay and unplanned readmissions) for patients who underwent surgical interventions. These secondary outcomes were evaluated with univariate and multivariate logistic regression models.

Results: Our cohort of 1066 patients had a median age at diagnosis of 17 years. Five hundred forty-nine (51.6%) were female, 824 (78.8%) were white, and 909 (14.7%) lacked any comorbidities. There were 861 (80.9%) treated by surgery and 168 (16.1%) received radiotherapy. 1-, 5-, and 10-year overall survival rates were 98.7% [95% confidence interval (CI), 97.8% - 99.4%), 96.2% (95% CI, 94.9% - 97.5%), and 91.9% (95% CI, 89.6% - 94.2%). Multivariable analysis demonstrated that insurance status of Medicare/Other government [hazard ratio (HR) = 3.79, p = 0.009) and of Medicaid (HR = 1.88, p = 0.035), and tumor grade being Grade 3 (HR = 4.34, p < 0.008) independently predicted shorter OS.

Conclusion : These data show long-term survival outcomes for pediatric patients with meningiomas. Sociodemographic variables were associated with both survival outcomes and utilization of treatment modalities. These findings underline disparities in healthcare utilization among this patient population.